April 1996 Bulletin

Future not bleak, says Dr. Sarmiento

While some of the complaints about the changes sweeping over medicine are justified, the future is not as bleak as some believe, Augusto Sarmiento, MD, told the incoming class of fellows at the Academy's Annual Meeting.

"In the great scheme of things, the so-called crisis of today will be nothing more than a footnote in the annals of history and medicine will continue to be one of the most gratifying and exciting professions," said Dr. Sarmiento, the 1991 Academy president.

"We are not witnessing a crisis in medicine, but simply, a socio-political upheaval. The erosion of our control over the care of patients has reached disturbing degrees as a result of government decrees or the actions of the newly-empowered private sector and business entrepreneurs. It makes one wonder whether the quality of care will be seriously compromised."

However, he said, eventually the problem will be resolved. "The American people will not tolerate second class medical care and will demand the quality of care to which they have grown accustomed and are entitled to receive," Dr. Sarmiento said. "I think that such an outcome is inevitable and suspect that a reasonable compromise where quality care is provided and cost is contained will be reached in the foreseeable future."

Dr. Sarmiento warned that the fragmentation of the specialty "trivializes orthopaedics and generates unhealthy divisive forces." He pointed out that "those in control of financing health care are stating in unequivocal terms that they are not going to cater to subspecialists as they perceive them to be the real culprits in the escalating cost of health care."

With increasing frequency, he said, "others in medicine are rendering care to patients with disorders of the musculoskeletal system which until recently had been treated exclusively by us. The erosion of orthopaedics has not yet ended. Make no mistake, third party payers are watching these developments with pleasure as they assume that in this manner the cost of care will be reduced."

He urged the fellows to demonstrate that orthopaedic surgeons are the best trained and qualified to provide surgical as well as nonsurgical treatment for conditions of the musculoskeletal system.

Dr. Sarmiento concluded that the new class of fellows "come onto the scene, not bad times, but in challenging times. You arrive at a time when we are losing our inheritance. Nonetheless, you can regain it. It requires only your will to action."

Change won't happen overnight, but he urged the fellows not to be discouraged by the magnitude of the task "and the fact that the history of mankind is heavy with unrealized possibilities. With Promethean tenacity, other generations succeeded in changing trends and philosophies that appeared unchangeable at the time. You need not follow the path, blaze a trail."

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